What to do before first appt with new psych? (hypothetical)

[CannonSalt]

So, my GP has been hinting fairly consistently that if I want to, he can easily arrange for me to see a particular psychiatrist.  My GP knows me well, so a consistent hint from him is probably worthwhile following up on.  Some time in the next millennium.

Given my recent history with my hyper-religious DBT provider and his colleague who tried to cover for his unethical behaviour, I am more depressed than I was, more anxious and feeling like I can't trust a professional to be professional.

Before I even think about going through with it, I'm curious as to what I can do to prepare for a hypothetical first appointment.  What would set me up for success in therapy, or at least, not a horrible trainwreck?  So far, I have printed out the section of the relevant legislation that covers patient rights... or is that coming on too strong???

[Appleblossom]

Dear @CannonSalt

I guess like all humans the psych will be individual and a lot will depend on how you both honestly gell .... cant know til you try.  I am impressed about your list of patients rights I think I will check that out too, but the key is not to lead with that ... that is only needed "in case" stuff goes wrong.

You made my ears pr ick up with your description of a hyper religious DBT provider ... I am interested to hear more about that experience ... I have though of going that route but maybe I dont need to line their pockets too.

One thing that might keep the prfessionals honest is knowing that we "clients" or "consumers" or "patients" have avenues to share and communicate ... even if we cant mention names we can alert each other to things that are seriously counter-productive.

Also a forum like this allows for ongoing monitoring ... developing an initial rapport is one thing ... but true ethics and valueing our experiences and rights takes a longer perspective and commitment.

[CannonSalt]

Thanks for your comment on the list - were you able to find something relevant there? 🙂

I guess I'm worried that I might not be able to gel, with anyone, yet.  I tend to switch off as a human being - if that makes sense - when people try to give me tough love, and I'm not confident of being able to negotiate if I end up in another crappy situation. I am aware that I'm waving around my tarbrush.  I'm not even really sure why I'd be going to therapy - my GP wants me to, and I'm still anxious, still depressed, and still need to work on some strategies to get ahead in life? Be effective in life?  That's such a ridiculous goal it isn't even a goal. 😛

I spewed a bit about my experiences with DBT guy in this thread, but feel free to ask further questions here.  I tried to add my impressions of the therapy too rather than solely spew - I think that you need to be always gung-ho motivated to do DBT. 

[MoonGal]

Hi @CannonSalt, It is always hard lining up again, to talk to a total stranger who may or may not have our own best interests at front and centre, isn't it?.

I understand why knowing patient rights is important and great thing to keep in the back pocket if neeed. If I am travelling reasonably well and feeling abit confident (other times i'm just a shattered mess..) But with anew practitioner, I usually start with some idea of what it is i hope to gain from sessions, as opposed to just re-telling the bnever-ending story.  I also treat the first session a bit like a job interview - with me being the employer and the practioner being the applicant. Not in an arrogant way, just guarded and careful in the first meeting so that I can access if this person is potentially going to be helpful or harmful.

I do a bit of 'homework' of my own before the first appointment so I am prepared and anchored to my own life and best interests.

Why am I going to the appointment? 
What of my (cornucopia) of problems might I want some clear help with at the moment?
How would the new practioner work with me, what style, what modality?

I kind of set an opening line, to start the tone of the first meeting... 

"I am here because I live with x,y.z and am still struggling with a,b,c and I am hoping to get some skills or insight into how I might do a,b,c better. How would you go about helping me with that?"

Then really listen to the way the practitioner answers the question,

Then explore with the practitioner how they may go about assisting me to make the gains. If they engage well with my fairly upfront first appointment and have  answered my unspoken question "will I be in the driver's seat or expected to be a passive recipient of this practitioner?". Then I will choose to disclose more personal information or to make another appointment or not. 

Sometimes just a mental health care plan and turning up and working with a focus towards a good goal can be really helpful, not trying to solve the entire world, or the entire past or anything, just help with 'this little bit" that really needs it.

Hope that helps. The "gel' does need to happen to some extent, but if we are working on a specific goal, like any tutition, we might have a chance to go in and out with a 'teacher' we do not particualry gel with and still learn something.

[Appleblossom]

That is a wonderful exposition of a great approach @MoonGal

I will re-read it before I go to my next psych .... I tend to do something similar but seeing it written out like that was great.

As you had a difficult experience with the last one @CannonSalt ... its totally sensible to be cautious ... good luck when you next give it a try.

[CannonSalt]

Thanks, @MoonGal - that's a good way to frame it. 'I live with XYZ and am struggling with ABC.'

I've found that in the past, when I've tried to do stuff like that, to lay out how I want things to be, that the psych will try and 'make me feel more comfortable with feeling vulnerable'... and I'm like... 'I already have so much practice with this you have no idea. can we please get on to the stuff that will actually make me feel like I have some kind of control over my life?'. This occurred most spectacularly with the recent psych, but has happened in the past too.

[MoonGal]

@CannonSalt - I am so sorry that happened to you! I am outraged on your behalf, how dare ANYONE - who we go to for help would use a tool to de-power and power over you in such a way, it is tantamount to abuse, no not even tantamount - it IS abuse.

We are already 'vulnerable' we are already fragile - how dare some one come at you with a sentence like "feel comfortable feeling vulnerable'. Grrrr. Let's keep us compliant, sick, needy, wallowing about in powerlessness. It is unconscionable behaviour.

I do reckon still, that if a practitioner is not prepared to work with you on your own terms, being clear that the terms are set out as goals in the pursuit of health, living skills and clarity about one's own needs then that person is NOT working in your own best interests. We struggle enough, we are somehow pathologised and victimised and made to stay that way, we all have huge challenges, why would a whole sector  (or parts thereof) of the helping proffesions want us to stay vulnerable? 

If we trust someone, once that trust is built, THEN we can be vulnerable and share the deeper parts, not on cue, and certainly not when someone demands us to drop our safety nets so they can feel like they are meeting whatever 'brief' 7 years of study taught them was necessary. 

If a practioner is not 100% on board in good outcomes with real life goals, what the hell are we doing there? Feeding them and their family? Lets find people who are willing, able and clear that this is OUR life, and they are here to assist us to live it. (Hope this is not too strident, but I really am very upset for you and hope you find someone who can assist with the ABC - not insist that you smear yourself into a helpless puddle. 

Of course, we will be further labelled as overly controlling, difficult and uncompliant if we do stand up and be clear about what we want and how we want to be in the drivers seat of our own lives when we can, to the best of our abilities. I wish you the very best, Cannonsalt (and any one who is or has experienced this 'power over') and hope we can by talking together and getting clear about what we need trend the conversations that happen in private doctors offices and psychs towards seeing that vulnerability in an of itself is not a great goal for already vulnerable people. It is a fine balance to walk, we need to hold our vulnerability and understand it and love it, but we do not have to turn it on like a tap when we step into some office somewhere because they demand it. 

[Appleblossom]

This discussion about vulnerability is hugely resonant for me.

It is partly why i couldnt turn of the tap of my tears for so long ... and alienated my girls ... I was kept encouraged to go to that place ... as the therapist indulged some theoretical notion about the importance of vulnerability ... but not help me addressmy day to day reality.

Thanks @MoonGal and @CannonSalt

[CannonSalt]

Hi @MoonGal - I feel I should clarify.  I didn't mean 'make me feel more comfortable with feeling vulnerable' as a direct quote, more as a way of expressing that from psych to psych, Step 1 has consistently seemed to be to try to help/force/make me bear that which I find unbearable, and Step Some-Time-Later, (with the last guy, On-The-Never-Never) seems to be where 'help me feel like I can take control of my life' sits.  Really, it goes in pairs - when you feel like you have some control, it is easier to bear a temporary setback, and to see it as temporary, rather than it being always true.  

Are there any other warning bells I should be listening for when 'interviewing' a prospective psych?  My last didn't want me to read non-fiction, either, because I was reading a news site which reports peer-reviewed psychological studies.  (Some 'good news' for us, some 'bad news' - I browse it with caution.)  I made the mistake of asking him about something I read there. 

I do find it hard to talk about my feelings beyond plainly labelling them when encouraged to do so.  I'm not even really sure what other kinds of 'talking about your feelings' there are?  So, on that level, I probably need to be able to come out of my shell a bit more.

[MoonGal]

Hi @CannonSalt, thank you for the clarification, HA i did rip into the 'make me feel more comfortable with feeling vulnerable' bit because i thought it was a quote, but, I also reckon that it is unethical to try to engender a sense of vulnerability as a pursuit in itself in therapy. {edited - further clarification - of course they may be sound clincal and psychological reasons for wanting people to access vulnerability, i would hope as part of the therapy that people would be knitted back up again before leaving the office however, as I have experienced this and know how devestating it is to try to drive home, be with family etc if left in a vulnerable state - I might be sailing too close to the wind with 'advice' on this and urge you to do what is the best for you. MG)

Maybe you could front foot it  (ie. say something along the lines of... I know I have a steel shell I use to protect myself, i know that I need to trust, but i do not want to 'explore' vulnerability for its own sake.)

Mmm, I would die with my legs in the air if I was told to 'not read non-fiction' what a crock of poo, really I mainline facts, science, research etc. We can and will be self-educating! I am glad you aren't seeing that practitioner any more, for your sake.

I always try to sit for 15 minutes outside the appoinment have a cuppa, jot down a few thoughts, centre and calm myself before going in to see any one - new or not. I try to set my 'intention' to get the most out of the time and remind myself I am doing it because I want to be the best I can be (not because I am sick and needy.)

I hope it goes well for you, @CannonSalt, you are already resilient because you have come this far.